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1. <br />2 <br />3 <br />4. <br />Average Age:Total Attendance: <br />UTILITIES <br />1. <br />4. <br />Number of dumpsters:5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Date: Event Coordinator: <br />TEMP EVENT APPEHD 16-02 <br />08/01/16 <br />2. <br />3 <br />5. <br />6. <br /> No <br /> No <br /> No <br />San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />Mo^T ^Tfi L <br />O/OC <br />Approximate attendance at peak time: <br />Page 1 of 11 <br />JZ Yes <br />S' Yes <br />Yes <br />Is potable water supplied and available for each food vendor: <br />Is electricity supplied and available for each food vendor: <br />Are janitorial facilities available: <br />Number of toilets provided: <br />Name of sanitary garbage disposal company: <br />Method of disposal of liquid waste for food booths: I <br />!/J i <br />AUG 1 2 2016 <br />ENVIRONMENT HEALTH <br />TEMPORARY EVENT APPLICATION permit/services <br />To be completed and signed by Event Coordinator, then returned to the Environmental Health Department with all <br />of the Food Vendor’s Applications no later than two weeks prior to event <br />Submit the following to the Environmental Health Department two weeks prior to the event: <br />a) Temporary Event Application <br />b) Application Review Fee of $139 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $139 per hour (weekdays 8:00 am to 5:00 pm) <br />• After regular business hours (weekday, weekends and holidays) the inspection is charged at the <br />hourly rate, calculated at one and one half times ($208.50 per hour) <br />This application is to be completed and signed by the Event Coordinator, then returned to the <br />Environmental Health Department with all Food Vendor’s Applications no later than two weeks prior to the <br />event. <br />ny <br />GENERAL EVENT FILE iNFORMATtON <br />Name of Event: S ~lRe/ltZES T M ' J ° __ <br />Date(s) of Event: Q - pl f / (b Time of Event: IV <br />Location’ tylS L^o Sr', Lovi; (Ftf, ____________ <br />Event Coordinator (Name):, J I elephone: Qu/} 3^^ - ‘I/// <br />Mailing Address: 3 Vi T>£~p Mo^T <br />Number of Food Booths: <br />I understand that as a temporary event coordinator, I am responsible for meeting California State <br />standards and the Environmental Health Department policies and procedures. <br />/